BRIEF PSYCHOTIC DISORDER: CAUSES, SYMPTOMS AND TREATMENT - ECONOMÍA - 2024

The brief psychotic disorder is a condition in which psychotic symptoms, including hallucinations, mental, delusions or disorganized speech obnubilación appear. It is distinguished from other psychotic disorders in that it appears suddenly, in its short duration (at least one day and at most one month), and in that after that period the patient usually recovers completely. Very rarely the episode is repeated more than once in the same person.

Another distinctive feature of Brief Psychotic Disorder is that it is not caused by schizophrenia, delusional disorder, bipolar disorder, schizoaffective disorder, drug use, or certain medical conditions such as a brain tumor.

The incidence and prevalence of this disorder is not exactly known, however, it is known to be a rare disorder. It seems to appear for the first time between the ages of 30 and 50, and it is more common in women than in men.

It is also associated with low socioeconomic status, with being an immigrant, or with the presence of personality disorders, such as paranoid or antisocial personality disorder.

Causes

The specific causes of this disorder are not known, but it is probably the result of a combination of hereditary, biological, environmental and psychological risk factors.

It has been found that brief psychotic disorder tends to run in the same family, so it follows that it must have some hereditary component. A family history of psychosis, or mood disorders such as depression or bipolar disorder, also appears to be a risk factor.

However, it is common for these genetic factors to be combined with stressors for the disorder to appear, such as family conflicts, traumatic events, work problems, serious illnesses, deaths of loved ones, uncertain immigration status, etc.

From the psychoanalytic point of view, it is affirmed that brief psychotic disorder appears due to an insufficiency in the coping mechanisms. In other words, the person does not have the necessary skills to defend themselves in an extremely stressful situation or that represents an unacceptable impulse. So this condition appears as a form of escape.

Other factors that seem to increase the risk of the appearance of brief psychotic disorder are the presence of toxins such as marijuana, or some medications.

The levels of neurotransmitters, those substances that allow nerve cells to communicate, also seem to influence. The main neurotransmitters involved are glutamate, dopamine, and serotonin.

Types of brief psychotic disorder

There appear to be three basic ways to classify brief psychotic disorders according to their trigger:

- If it arises from an identifiable stressor: it is also called brief reactive psychosis, and it occurs caused by a trauma or a very stressful event for the person. For example, an accident, assault, the death of a loved one, or a natural disaster.

- No identifiable stressor: in this case, apparently there are no stressors or trauma that could have caused the disorder.

- If it arises after childbirth: this type only happens, of course, in women, approximately within 4 weeks after giving birth.

According to Nolen-Hoeksema (2014), approximately 1 in 10,000 women experiences Brief Psychotic Disorder shortly after delivery.

Symptoms

As mentioned, symptoms must be present for at least one day and at most one month. If they last longer than 6 months, it is possible that it is another disorder such as schizophrenia.

Several of these symptoms (such as delusions and hallucinations) have traditionally been linked to excessive amounts of dopamine or its receptors in the mesolimbic pathway of the brain.

The main symptoms of Brief Psychotic Disorder are:

Delusions

These are beliefs that the patient holds very firmly but that do not have a rationale, cannot be demonstrated through experience, or are inappropriate with respect to their culture.

Also, even if they are shown otherwise, the person will ignore the evidence that contradicts their ideas and will continue to defend them.

There are many types of delusions, but the most common are delusions of persecution (you think they are looking for you or want to hurt you), of greatness (you think you are an exceptional person, with supernatural talents), delusions of reference (you suspect that everything see or hear is directed at him, offending him), among others.

Hallucinations

Another symptom of psychosis is hallucinations. In this case, the patient vividly experiences events that have not actually occurred. Also, believe with complete certainty that your experiences are real. This differs from perceptual distortions, which, in this case, the individual suspects that they are the result of his mind.

Hallucinations, on the other hand, consist of seeing, hearing, feeling or smelling elements that do not exist, since only the affected person can perceive them.

Disorganized thinking

The logical relationship of your thoughts is lost, so that ideas arise chaotically without having anything to do with each other.

Disorganized or nonsensical language

As a consequence of disorganized thinking and attention and memory problems, language is markedly affected.

Specifically, these patients seem to link nonsensical phrases, talk about the same topic continuously, or jump suddenly from one topic to another. In short, their language is full of inconsistencies.

Catatonic behavior

It refers to a wide variety of motor abnormalities. They can be immobility, excessive activity with great agitation, extreme negativism (or resistance to following instructions or being mobilized for no apparent reason), or muteness (lack of speech).

Also included here are stereotyped movements, echolalia (unnecessarily repeating the words that the interlocutor utters) or echopraxia (involuntarily repeating the movements that the interlocutor makes).

Disorganized behavior or strange behaviors

These are behaviors that are out of common sense such as eating soup with a fork, undressing in public, laughing when it is not socially convenient to do so, etc.

Changes in habits

Such as altered sleep and meal schedules, as well as energy or activity levels. It is also common to observe, as a result of routine changes, weight gain or loss.

Others

- Disorientation and confusion

- Alterations in attention and memory: specifically, a reduction in these capacities.

- Neglect in personal hygiene and clothing.

- Inability to make decisions.

Diagnosis

First of all, it must be taken into account for the diagnosis that the behaviors are culturally appropriate. That is, they coincide with the culture, beliefs and religious activities that predominate in the patient's environment.

In the DSM V (Diagnostic and Statistical Manual of Mental Disorders), a series of criteria have been established to make the diagnosis of brief psychotic disorder.

The patient must necessarily present 1 or more of the following symptoms: delusions, hallucinations or disorganized language. Another symptom that is included in the list is catatonic or very disorganized behavior.

The manual indicates that behaviors that are culturally accepted cannot be included as symptoms. An example would be talking to God. We cannot consider it a symptom if the person is very religious and is considered normal in their environment.

Another diagnostic criterion is that the disorder lasts for at least one day and a maximum of one month, and then return to the previous state that existed before the disease.

Finally, it is indicated that the disorder cannot be attributed to the physiological effects of any substance such as a medicine or drugs, a medical condition; or another mental disorder such as major depressive disorder, bipolar, or other psychotic disorders.

On the other hand, it is necessary to specify what type it belongs to (which have been listed above). That is, if it is caused by a very obvious stressor (brief reactive psychosis), if it does not have notable stressors, or if it appears after childbirth.

To complete the diagnosis, the severity of the disorder can be specified using a 5-point scale (0 means absent and 4 the maximum severity). This is quantitatively evaluated according to the delusions, hallucinations, speech, behavior and negative symptoms (apathy, lack of interest, depression, isolation). However, the diagnosis of Brief Psychotic Disorder can be made without specifying the severity.

Forecast

This disorder generally has a good prognosis. This is because it lasts less than a month and then the patient returns to his previous functioning state.

A better prognosis has been associated with a sudden onset, a short duration of symptoms, an absence of schizoid personality traits, confusion and disorientation, an identifiable and very intense stressor, a lack of a family psychiatric history, and a good adaptation to the environment before the illness. In these cases, it is very difficult for the brief psychotic disorder to reappear in the future.

The prognosis is even better if patients do not have a history of psychiatric or other disorders that developed before the Brief Psychotic Disorder. Fortunately, according to studies carried out in Europe, between 50 and 80% of patients do not have significant additional psychiatric disorders.

However, other minority cases later develop chronic mental disorders such as schizophrenia or mood disorders.

On some occasions, once the psychotic symptoms are resolved, depressive-type symptoms may occur that must also be treated.

Treatment

By definition, brief psychotic disorder resolves in less than a month. However, one must be cautious and treat this disorder as soon as possible, as it is associated with a great risk of harming yourself or others. As well as the probability of committing suicide, which is higher during psychotic episodes (especially if there are depressive symptoms).

Another reason for a consultation as soon as possible is that brief psychotic disorder may be a sign that another serious mental disorder is developing. In fact, it is not known until a month has passed whether it was a brief psychotic disorder or the onset of another condition with similar symptoms, such as schizophrenia.

Therefore, treatment is essential, which will be similar to that established for an acute episode of schizophrenia.

Education

In principle, once the patient has been diagnosed, it is essential to educate him and his family about the disease in detail. In addition to explaining the type of treatment and possible side effects of the medications.

Medication

Medication is essential to alleviate psychotic symptoms and stabilize the patient. The most widely used are the antipsychotic drugs that are commonly used for schizophrenia. Among these are the typical antipsychotics or "neuroleptics" such as haloperidol, loxapine, chlorpromazine, thioridazine, perphenazine, fluphenazine, etc.

These drugs tend to be effective for positive symptoms (hallucinations, delusions…) but not for negative ones. In addition, they can cause side effects that affect the nervous system, such as muscle stiffness, tremors or nervousness.

For this reason, the newer, atypical antipsychotics, such as risperidone, olanzapine, ziprasidone, clozapine, etc. are commonly used.

On the other hand, since people with Brief Psychotic Disorder are at higher risk of also presenting depressive symptoms, antidepressant medications are sometimes included. These are often serotonergic drugs such as: fluoxetine, sertraline, paroxetine, citalopram, etc.

If the patient is also very anxious or has sleep disturbances, tranquilizers such as diazepam or lorazepam may be prescribed. Doses and the perfect balance vary from case to case and should be adjusted by a medical professional.

Therapy

It has also been found that cognitive-behavioral psychological therapy is essential for the correct recovery of the person. This will help the patient to understand their condition, to find the possible origin of the disorder, and to manage their thoughts and behaviors to make them more adaptive.

References

1. American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
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6. Nolen-Hoeksema, Susan (2014). Abnormal Psychology (6th ed.). New York, NY: McGraw-Hil Education. pp. 230–231.
7. Schulz, S. (July 2016). Brief Psychotic Disorder. Obtained from MSD Manual.